Asia Oceania Journal of Nuclear Medicine & Biology
Volume:10 Issue: 1, Winter and Spring 2022

We investigated the detectability of somatostatin receptor scintigraphy (SRS) for neuroendocrine neoplasms (NEN). From January 2016 to October 2020, 125 SRS examinations using indium-111 pentetreotide performed for patients with NEN lesions were retrospectively evaluated. The detection rate of NEN lesions was determined according to histopathological classification by primary site and by organ. At least one NEN lesion was detected in 73% (91/125) with a positive Krenning score of ≥2 in SRS. The detection of abdominal NENs (gastrointestinal tract, 38; pancreas, 62; and others, 14) was 89% (49/55) for neuroendocrine tumor(NET)-grade (G) 1, 78% (32/41) for NET-G2, 66% (2/3) for NET-G3, 31% (4/13) for neuroendocrine carcinoma (NEC), 100% (1/1) for mixed neuroendocrine–nonneuroendocrine neoplasm, and 0% (0/1) for non-classified NEN. That of thoracic NENs was 33% (2/6) for typical carcinoid tumor and 40% (2/5) for atypical carcinoid tumor. For a total of 226 organ lesions, hepatic lesions were 76% (58/76); pancreatic lesions, 61% (31/51); lymph node lesions, 77% (27/35); bone lesions, 83% (20/24); duodenal lesions, 82% (9/11); and other lesions, 41% (11/27). The detectability of SRS for NEN in Japan was verified at a center, and its usefulness was confirmed.

Objevtive(s): Neuroendocrine tumors are a heterogeneous group of neoplasms that arise from the peptide-producing cells of the neuroendocrine system. Different functional imaging methods have been suggested to diagnose NETs. There is still not enough evidence to recommend 68Ga-DOTATATE as a standard diagnostic tool in NETs. Therefore, the aim of this study was to assess the value of 68Ga-DOTATATE scan in detecting NETs. This was a cross-sectional study. All patients with a pathologically confirmed NET tumor referred to Masih Daneshvari Hospital affiliated to Shahid Beheshti University of Medical Sciences entered the study. Patients underwent a 68Ga-DOTATATE PET/CT. All statistical analysis were performed by SPSS software version 18. Forty patients with a mean age of 48.1±15.80 years entered the study. Twenty-one (52.5%) were male and 19 (47.5%) female. In the studied patients, neuroendocrine tumor was present in 19 cases (47.5%) in pancreas and gastrointestinal tract, 9 (22.5%) in lung, 3 (7.5%) in mediastinum and adrenal gland, 6 cases (5%) in liver and 3 other sites. There was no significant association between mean age and gender with primary location of the tumor. The meanSUVmax was 11.62±20.02 and the the mean tumor size was 38.25±31.35 mm. The mean size of the metastasis was 40.55±24.53 mm. The mean percentage of ki-67 was 12.54±18.40. There was no significant correlation between SUVmax of the lesion and age (r=0.063, P=0.701), tumor size (r=-0.63, P=0.067) or Ki-67 (r=0.011, P=0.960). In 20 cases, metastases were reported, of which 14 were (70%) in the liver, 3 in the lungs (15%), 2 in the gastrointestinal and cervical lymph nodes, and 1 in the bones and pancreas(%5).68Ga-DOTA-peptide PET/CT could find the primary or metastasis sites of NETs with good quality images. In general, this modality can enhance the management in patients with NETs.

18F-FDG PET/CT is increasingly performed in patients with differentiated thyroid cancer. The aim of this study was to assess the clinical impact of 18FFDG PET/CT on the management of patients with differentiated thyroid carcinoma who had elevated serum thyroglobulin (Tg) and negative 131I whole body scan (WBS) . 67 patients with differentiated thyroid carcinoma were included in this study. The findings of 18F-FDG PET/CT imaging were compared with histopathology, follow up imaging, or clinical follow-up results. The diagnostic accuracy of 18F-FDG PET/CT was evaluated for the entire patient group and for those patients with stimulated serum thyroglobulin levels of less than 5, 5–10, and more than 10 pmol/L as well as for local recurrences and metastases sites. The impact of 18F-FDG PET/CT on therapeutic management was also evaluated. 30/67 patients had positive findings on 18F-FDG PET/CT; 28 were truepositive and 2 were false-positive. 18F-FDG PET/CT results were true-negative in36 patients and false-negative in 1 patient. The overall sensitivity, specificity, accuracy, PPV and NPV of 18F-FDG PET/CT were, 96.5%, 94.5%, 95.5%, 93.3%, and 97.2% respectively. Positive 18F-FDG PET/CT findings were directly correlated with stimulated serum thyroglobulin levels, 7.1% had Tg between 5–10, and 92.9% had Tg greater than 10 pmol/L. 18F-FDG PET/CT had a high or moderate impact on treatment management in 28 (41.8%) of patients. 18F-FDG PET/CT is able to improve diagnostic accuracy and have management impact in a therapeutically relevant way in patients with differentiated thyroid carcinoma who present with rising thyroglobulin level, negative 131I WBS, and clinical suspicion of recurrent disease.

Accurate detection and competent management of thyroid nodules, as a common disease, basically depends on the reliability of the ultrasonography (US) report. In this research, we evaluated inter and intra-observer variation among ultrasonography reporters, based on ACR-TIRADS. In this retrospective study, 345 thyroid US images of 150 patients were reviewed. Three clinicians with at least 6-year experience in thyroid US reviewed the images twice at 6-8 weeks’ intervals. Composition, echogenicity, shape, margin, and echogenic foci based on ACR-TIRADS were reported, independently. Inter and intra-observer variations were calculated based on Cohen’s Kappa statistics. 345 ultrasonography images of 150 patients with thyroid nodules (83 women and 67 men) with a mean age of 65 years were reviewed. Moderate to the substantial intra-observer agreement was achieved with the highest Kapa value in the category of shape (k=0.61-0.77). For TIRADS level, the moderate intra-observer agreement was observed (k=0.42-0.46). Inter-observer agreement for the US category of thyroid nodules was obtained slightly to moderate. Composition (k=0.42 and 0.51) and echogenicity (k=0.45 and 0.46) showed the highest overall agreement and margin showed the lowest overall agreement (k=0.18 and 0.19). In assessing TIRADS level of nodules, a fair agreement was obtained (k=0.23 and 0.29) . Moderate to substantial intra-observer agreement and slight to moderate inter-observer variation for evaluation of thyroid nodules; shows the need for a computer-aided diagnosis system based on artificial intelligence to assist our physicians in differentiating thyroid nodule characteristics based on explicit image features. An additional training course based on ACR-TIRADS for physicians can be another useful recommendation.

Testicular germ cell cancers are the most common solid malignancy among young men at the age ranging between 14 and 35 years. In this study, we evaluated the feasibility of sentinel lymph node mapping using intraoperative injection of radiotracer in nonseminomatous testicular cancer patients with history of orchiectomy who were candidate for retroperitoneal lymph node dissection (RPLND) in post-chemotherapy setting. Nine consecutive cases were included in the study. Technetium-99mlabelled phytate was injected in two divided doses in the stump of the spermatic cord, through transabdominal approach. A hand-held gamma probe was used for radio-guided retroperitoneal sentinel lymph node detection intraoperatively and confirming the location of the sentinel lymph nodes. Detection rate and the false negative rate were estimated as the main indices. The detection rate was 6/9 (66%) and the false negative rate was 0/2 (0%). Location of the dissected sentinel lymph nodes were interaortocaval (2patients),internal iliac (1 patient), external iliac (1 patient), common iliac (2 patients), and paraaortic (1 patient). Sentinel lymph node mapping technique seems to be feasible and promising in post chemotherapy non-seminoma testis cancer patients who are candidate for RPLND; however, further larger studies are needed to increase and standardize the detection rate.

Hypersensitivity pneumonitis (HP) is an interstitial lung disease resulting from an immune-mediated response in susceptible and sensitized individuals to various inhaled antigens in the environment. Imaging diagnosis is usually based on high-resolution CT findings. Here, we present a 49-year-old man with a history of diffuse large B-cell lymphoma presented with fever and occasional cough. 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) revealed diffuse FDG uptake in the bilateral lungs. Expiratory low-dose CT simultaneously performed in PET scanning revealed centrilobular nodules and air trapping in ground glass opacities (GGO). Our imaging diagnosis was acute hypersensitivity pneumonitis (HP). Based on the results of his clinical course, blood laboratory tests, and bronchoscopy, he was diagnosed with acute HP. Diffuse pulmonary FDG uptake can be seen in the patients with acute HP. In addition, expiratory low-dose CT findings of centrilobular nodules and air trapping in GGO may be helpful for accurate diagnosis of acute HP.

18F-Flurodeoxyglucose (FDG) PET/CT has been considered the modality of choice in detecting, staging, restaging and following-up with lymphoma patients. However, it has an uncertain role in differentiating hepatic lymphomatous relapse from other granulomatous diseases such as in candidiasis or sarcoidosis. Therefore, it is important to correlate the imaging findings with other modalities such as ultrasound, CT scan, MRI, and histology to direct the diagnosis and treatment. We present a case of a 33-year-old woman with large B-cell lymphoma in complete remission following treatment presenting with neutropenic fever following her final cycle of chemotherapy. Ultrasound of the abdomen and enhanced CT scan of the abdomen and pelvis were negative. The FDG PET/CT scan showed multiple FDG-avid hypodense hepatic lesions that were suggestive either of lymphoproliferative involvement or nonmalignant process. However, MRI of the abdomen performed four days later was suggestive of an infectious process, rather than a lymphoproliferative disorder. A subsequent CT-guided biopsy of a hepatic lesion showed granulomatous inflammation, with no evidence of malignancy or Tuberculosis. The patient was started on Caspofungin followed by Fluconazole. After 5 weeks, the clinical condition resolved, and the subsequent FDG PET/CT showed complete resolution of the FDG-avid multiple hepatic lesions.

Hypercalcemia is a clinical condition characterized by elevated circulating serum calcium levels either due to raised parathyroid hormone in hyperparathyroidism or due to secondary causes of hypercalcemia without elevated parathyroid hormone levels. However, hyperthyroidism may occasionally present with incidentally detected hypercalcemia. We present a case of a 53-year-old woman with a previous history of an underlying thyroid disorder, now presented with features of hypercalcemia and mildly elevated parathyroid hormone levels. Her ultrasonography of the neck was suggestive of an intra-thyroidal parathyroid adenoma and it was localized as a tracer avid lesion within the thyroid gland on dual-phase 99mTc-sestamibi planar scintigraphy with single photon emission computed tomography/ computed tomography (SPECT/CT). However, a subsequent thyroid profile followed by 99mTc- pertechnetate thyroid scintigraphy showed a hot nodule in the thyroid gland which changed the diagnosis to a toxic thyroid adenoma. She was treated with radioactive iodine ablation and thyrotoxicosis resolved and the serum calcium levels normalized on her follow-up.

To illustrate incidental 18F-FDG PET-CT findings and related CT alterations of suspicious pulmonary interstitial involvement in asymptomatic oncologic patients during the first COVID-19 outbreak in the core of Italian peak. We retrospectively evaluated the 18F-FDG PET-CT follow-up examinations performed during the first Italian COVID-19 outbreak (March 3rdApril 15th, 2020) in 10 asymptomatic oncologic patients with a highly suspicious interstitial pulmonary involvement on CT. Six cases were confirmed SARS-CoV-2 by molecular tests. The following parameters were assessed: 1) lung involvement on co-registration CT as extension (laterality, number of lobes), pattern (groundglass opacities/GGO, consolidations, mixed) and stage (early, progressive, peak, and absorption); 2) the maximum standardized uptake value (SUVmax) of lung lesions on 18F-FDG PET. The involved lobes were 5 in 5 cases (3 confirmed SARS-CoV-2), 2-4 in 4 cases and 1 in 1 case. GGO were found in all patients; 3 cases also showed a combination of GGO and peripheral consolidations (mixed). Five cases were suggestive for an early stage of interstitial pneumonia, 4 for progressive and 1 for peak. All the lung lesions showed increased FDG uptake. In early stages SUVmax ranged from 1.5 to 11, in progressive from 3.3 to 6.8, in peak from 2.4 to 7.7. SUVmax ranged 1.5-11 in patients with only GGO and 2.8-7.7 in those with mixed pattern. 18F-FDG PET-CT findings in suspected COVID-19 pulmonary involvement of asymptomatic oncologic patients showed an increase in FDG uptake of GGO and consolidations, but with a wide and apparently nonspecific range of SUVmax values.

This is a 51-year-old male who presented with abdominal pain, bilateral proximal upper and lower extremities pain and weakness, and decreased urine output with abnormal kidney function test; Urea and creatinine levels were elevated at 231.5 mg/dl and 11.05 mg/dl, respectively. Initial bone scan showed increased uptake within several muscles suspicious for polymyositis, this was confirmed by biopsy of the right triceps, identified by bone scan as the best superficial biopsy site. Pelvis and thigh MRI demonstrated diffuse hyperintense signal on fluid sensitive sequences involving several muscles. Renal biopsy showed acute tubular injury. He was treated with steroids resulting in significant improvement. A repeat bone scan showed near complete resolution of the muscular uptake seen at presentation. This case nicely illustrates the role of bone scanning in the initial recognition and determination of the extent of polymyositis with identification of a suitable biopsy site as well as assessment of response to treatment.

to assess the knowledge and perception of nuclear medicine by radiologists in French-speaking sub-Saharan Africa.

cross-sectional study conducted from April 8 to June 7 2020 including radiologists practicing in French-speaking sub-Saharan African countries. Data were collected electronically via a google form.

Of the 142 radiologists surveyed, 45.8% had already completed an internship in Europe, 3.52% in a nuclear medicine department and 72.54% had a nuclear medicine department in their country of practice. Among these radiologists, 21.13% knew the three main techniques of nuclear medicine and only 9.15% knew that nuclear medicine allows functional, metabolic and molecular studies. On average, 56.8% were aware of clinical indications for the main fields of nuclear medicine. In 47.18% of cases, they thought that scintigraphic imaging was more irradiating than radiological imaging, 71.1% knew about hybrid imaging techniques, 43.66% had read a scientific article on nuclear medicine, 4.93% had attended a nuclear medicine conference and 28.9% had recommended a scintigraphic imaging examination in their report. Half of them would like to see nuclear medicine and radiology merged into a single specialty and 95.77% considered it essential to create a nuclear medicine department in their country.

The level of knowledge of radiologists in French-speaking subSaharan Africa about nuclear medicine was, on the whole, unsatisfactory with a generally encouraging perception.

This series involves a quiz pertaining to the identification of key anatomical landmarks and normal structures present at a given level on the computed tomography (CT) image. The current quiz demonstrates examples of normal and abnormal axial CT images at the level of origin of the coeliac artery. The representative image is subsequently followed by further images demonstrating various commonly encountered pathologies found at this level in clinical practice. In each image, readers are expected to identify highlighted anatomical structures and appreciate how given pathologies can alter the appearance of normal structures. This series aims to advance understanding of sectional anatomy and aid nuclear physicians in the interpretation of the CT component of single photon emission computed tomography (SPECT) and positron emission tomography (PET) studies.